But then I veered away somewhat from the cancer script and broached the ongoing pandemic. The immunocompromising effects of chemotherapy coupled with Ms. R’s advanced age and comorbidities meant that covid-19 precautions, specifically masking, should be automatic for her and for those around her to dampen any infection risk. (I am identifying her by her initial to protect her privacy.)
Visibly inflamed by this last bit of medical advice, Ms. R howled back at me. And right there in the exam room, she harangued me about “breathing,” “mask nonsense,” “liberals,” the “media” and “control.”
As the pandemic has become increasingly politicized, the effects have seeped into the doctor-patient relationship. I regularly witness patients malign the medicine and science that undergird our efforts against covid-19, the disease caused by the novel coronavirus.
And though physicians have embraced political activism and advocacy outside the walls of the hospital and clinic, medical conventions dissuade them from engaging their patients directly on any subject that is tinged with politics. But when politics become a harm to health, the Hippocratic oath, which requires us to treat patients to the best of our ability, compels doctors to act. As someone who swore fealty to science and public health and who has intimately witnessed the suffering wrought by coronavirus, this is my obligation.
The initial impulse was to hope that this discomfiting moment would pass on its own. Medical school, clinical training and board certification exams had not prepared me to examine or treat the politics of my patients.
Although it was possible for me to address the charged issue of masks simply with a smile and hasty transition back to Ms. R’s cancer, the coronavirus had made such a move impermissible. For an oncologist who was trying to push forward against the considerable weight of metastatic cancer and a pandemic, the grave decision to wear a mask could not be left to a patient’s political leanings.
Further, being an oncologist meant that I was comfortable with being uncomfortable. Telling patients what they did not want to hear was necessary whenever I spoke about hospice or treatments that were palliative and not curative in their goal.
I also understood that the abstract public health recommendations behind widespread mask use would need to be humanized for Ms. R. She needed to experience the science instead of hearing about it from politicians and talking heads.
I grabbed a spare surgical mask and provided an animated explanation of how the covering protected the wearer and those nearby. This was supplemented with stories about masking from my own personal and clinical life. While I had her ear, it also made sense to add a morsel of data on how much masks reduced transmission of coronavirus.
Ms. R affirmed it all tersely by saying, “I like you.” She trusted me to treat her cancer. And our exchange showed that this trust could be stretched to also…
Read More: Coronavirus anti-science attitudes can harm my patients